Healthcare Provider Details

I. General information

NPI: 1265695365
Provider Name (Legal Business Name): CAROLYN JULIETTE MORIN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 MERRILL ST
FARMINGDALE ME
04344-1622
US

IV. Provider business mailing address

14 MERRILL ST
FARMINGDALE ME
04344-1622
US

V. Phone/Fax

Practice location:
  • Phone: 207-626-3091
  • Fax: 207-626-5499
Mailing address:
  • Phone: 207-626-3091
  • Fax: 207-626-5499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4066
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: